Provider Demographics
NPI:1184705022
Name:MILANOVICH, PHILIP JOHN (BS DDS MS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:MILANOVICH
Suffix:
Gender:M
Credentials:BS DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S 4TH AVE
Mailing Address - Street 2:ABC ORTHODONTICS
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:482-726-0990
Mailing Address - Fax:
Practice Address - Street 1:2450 S 4TH AVE
Practice Address - Street 2:ABC ORTHODONTICS
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:482-726-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics